3614-BD Insulin Adjust Workbook

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Insulin Adjustment and Pattern Management – Adjusting insulin doses based on a pattern of blood glucose readings over three days or more is called “Pattern Management,” or “Pattern Control.” If your blood glucose is too high or too low at certain times of the day or night, an adjustment to your insulin dose may be needed. In this case it is helpful to look for patterns in your blood glucose readings over three days or more. For example, take a look at Jean’s blood glucose readings before dinner for the past three days: JEAN’S THREE-DAY BLOOD GLUCOSE RECORD (Goal 90 mg/dl-130 mg/dl) Breakfast Lunch Dinner Bedtime 98 mg/dl 129 mg/dl 250 mg/dl 150 mg/dl 89 mg/dl 105 mg/dl 225 mg/dl 111 mg/dl 102 mg/dl 88 mg/dl 240 mg/dl 138 mg/dl You can see that her dinner numbers are all too high. The problem may be related to how much carbohydrate (carb) she ate at lunch, snacking, schedule or basal insulin. However, it is most likely that her food at lunch did not match her pre-lunch bolus. She ate too much carb for her insulin bolus dose. For more information on Pattern Control or Pattern Management, see the BD Publication: Pattern Control. Insulin Sensitivity Factor (ISF) and Correction – • ISF is the amount that one unit of rapid- or short-acting insulin will lower your blood glucose reading. It is used to calculate your correction or supplemental dose. • Correction dose is the amount of insulin you need to correct a high blood glucose level and bring it into the range your blood glucose should fall into most of the time. Once you know your ISF, you can give yourself the right dose of insulin to keep you within your blood glucose goals. The ISF is different for different people and your Diabetes Team will help determine it for you. For instance, if your blood glucose at lunch is 200 mg/dl and your goal is 90-130 mg/dl, you will learn to take a correction dose, an extra amount of rapid- or short-acting insulin to bring your high blood glucose down to the range your blood glucose should be in most of the time. Correction is usually required before a meal, so you will need to add or subtract this dose of insulin to the amount of insulin needed for your carbohydrate intake. The correction dose is extra insulin if your blood glucose is too high or a lower insulin dose if your blood glucose is to low. 7
EXAMPLE: Calculating Laurie’s Correction Dose • Laurie’s ISF is 1 unit of rapid or short acting insulin for every 50 mg/dl of blood glucose. • Her target pre-meal blood glucose is 100 mg/dl, but her pre-dinner blood glucose reading is 250 mg/dl. • She is 150 mg/dl over her target level. Current blood glucose – target blood glucose = amount of glucose over target [250 mg/dl – 100 mg/dl = 150 mg/dl] • Using Laurie’s ISF, she would divide 150 mg/dl by 50 to find that she would need to add an extra 3 units of rapid or short acting insulin to her meal-time dose to correct the blood glucose to 100 mg/dl. Amount of glucose over target ISF [ 150 = 3 50 ] = correction dose If Laurie’s pre-dinner blood glucose was 75, she would reduce her insulin dose in the same manner as outlined above. • Her target pre-meal blood glucose is 100 mg/dl, but her pre-dinner blood glucose reading is 75 mg/dl. • She is 25 mg/dl below her target level. Current blood glucose – target blood glucose = amount of glucose over target [75 mg/dl – 100 mg/dl = -25 mg/dl] • Using Laurie’s ISF, she would divide 25 mg/dl by 50 to find that she would need to subtract 0.5 units of rapid or short acting insulin to her meal-time dose to correct the blood glucose to 100 mg/dl. Amount of glucose = correction dose over target ISF [ -25 = -0.5 units 50 ] Peak Action – The time when insulin is working the hardest to bring blood glucose down. It is essential to know when your insulin peaks so that you can prepare for possible low glucose levels at these peak times. Types of insulin with peak action times are: Name of Type of Peak Action Insulin Insulin Humalog ® , Rapid 30 min. to Novolog ® , 1 1/2 hours Apidra ® Lantus ® Long No peak action *Regular Short 2 to 4 hours *UltraLente ® Long 8 to 30 hours *NPH Intermediate 4 to 12 hours *Lente ® Intermediate 7 to 15 hours *Not commonly used in Flexible Insulin Therapy 8
Page 1 and 2: TARGET THERAPY Staying on Target TM
Page 3 and 4: INTERACTIVE TABLE OF CONTENTS To go
Page 5 and 6: WHAT IS BASAL-BOLUS? When you have
Page 7 and 8: TERMS TO LEARN FIRST 4
Page 9: NOTE: For an algorithm to work you
Page 13 and 14: MAKING BOLUS INSULIN CHANGES Your f
Page 15 and 16: Blood Glucose Monitoring: When to T
Page 17 and 18: Q&A PRACTICE PROBLEMS Q - What is t
Page 19 and 20: ange without any insulin changes. A
Page 21 and 22: Ken’s Algorithm for Correction Me
Page 23 and 24: PRACTICE PROBLEMS: Blood glucose ta
Page 25 and 26: Fill in your pre-meal blood glucose
Page 27 and 28: If you had a “low blood glucose
Page 29 and 30: Method I: A Quick and Easy Way to S
Page 31 and 32: Method I - Insulin Dosing Based on
Page 33 and 34: PUTTING IT ALL TOGETHER 30
Page 35 and 36: Your Night Out - Using the Five Ste
Page 37 and 38: ADJUSTING THE BASAL INSULIN DOSE 34
Page 39 and 40: 7. Your graph should look like one
Page 41 and 42: Option II: See if your basal rises
Page 43 and 44: TROUBLESHOOTING Sometimes you may f
Page 45 and 46: Which Insulin is the Problem? 1. Ba
Page 47 and 48: PROBLEM SOLVING AND EXERCISES 44
Page 49 and 50: By lowering the 10 PM to 3 AM basal
Page 51 and 52: Juan Has Had a Change in His Blood
Page 53: SEE - YOU REALLY CAN DO IT! This wo

3614-BD Insulin Adjust Workbook

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